Life's essential 8 score and 10-year cardiovascular outcomes in atrial fibrillation: A UK biobank analysis with simulated lifestyle improvement

Background: Atrial fibrillation (AF) is associated with high risks of mortality and cardiovascular events, yet the prognostic value of comprehensive lifestyle and clinical health metrics remains uncertain. Objective: To investigate whether cardiovascular health (CVH), as measured by the American Heart Association's Life's Essential 8 (LE8) score, is associated with clinical outcomes in people with AF, and to estimate the impact of simulated improvement in CVH components. Methods: Data were drawn from the UK Biobank, a prospective population-based cohort. Participants with AF were identified using ICD codes. CVH was assessed using a modified LE8 score (range 0-100), derived from smoking status, cholesterol, blood pressure, BMI, HbA1c, physical activity, diet, and sleep. Primary outcomes were all-cause mortality and major adverse cardiovascular events (MACE: ischaemic heart disease, myocardial infarction, stroke, and heart failure). Associations were analysed using Cox models with penalised splines, presented in Kaplan-Meier curves. Population attributable and potential impact fractions were estimated. Results: < 0.001). Associations were modified by age and multimorbidity. Simulated improvements in CVH could reduce all-cause mortality by 10% and MACE by 7%, with diet, smoking, blood pressure, and BMI contributing most. Conclusion: Higher LE8 scores were independently associated with lower all-cause mortality and MACE risk in people with AF, supporting the role of lifestyle-based secondary prevention in AF care.